![]() If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. 4,5 At the same time, the number of patients classified as low risk increases to up to a third of the presenting cohort-an improvement that, by itself, ought to retire TIMI to its intended place on the inpatient side.Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. When used as recommended by the authors, a HEART Score of 0 to 3 reflects a six-week event-free prognosis with a miss rate ranging between 0.6 percent and 1.8 percent in validation studies. 3 Reflecting several elements common to clinician gestalt, HEART demonstrates substantially improved performance over TIMI. From the Netherlands, the HEART (History, ECG, Age, Risk Factors, Troponin) Score was derived and designed for use in the emergency department. The development of these ED-centric decision instruments and disposition pathways indicate EM has moved beyond the hand-me-downs from cardiology.įortunately, science marches on. ![]() Pursuing this strategy is clearly foolish. 2 This strategy would result in 78 percent of patients being admitted for cardiac evaluation and still result in adverse outcomes for one in 50 discharged patients. As expected, the largest meta-analysis of prospective studies using TIMI in the emergency department demonstrated even requiring a TIMI of 0 for discharge is only 97.2 percent (95 percent CI, 96.4–97.8) sensitive for cardiac events. The generalizability of this cohort to our setting is simply lacking, and the logistic regression identifies elements-aspirin use within seven days-that may add specificity for poor outcomes in an intermediate- to high-risk cohort but fails in providing utility for describing a minimal-risk cohort. The original predictive value of the TIMI Score was intended to prognosticate 14-day mortality or new cardiac ischemia for cardiac inpatients, not emergency department presentations. These were patients admitted and anticoagulated for concerning chest pain in the setting of ECG changes, known coronary artery disease, or positive biomarkers. The original TIMI Score is not derived from an emergency department cohort. Fortunately for EM, but unfortunately for the brain cells sacrificially dedicated to its memory, the next wave of decision instruments promises to eliminate it from use. Numerous studies have utilized it, attempting to define a low-risk cohort from unselected chest pain patients presenting to the emergency department. Over the last decade, this score has been drilled, dogmatically, into many specialties, including emergency medicine. Many Patients Skip Prescribed Drugs After Myocardial InfarctionĮxplore This Issue ACEP Now: Vol 33 – No 04 – April 2014Ĭan you recite the elements of the TIMI Score-the Thrombolysis in Myocardial Infarction Risk Score for Unstable Angina/Non-ST Elevation Myocardial Infarction-from memory? 1 If you still can, it’s not surprising.ACEP15 Session: Latest Recommendations for Non-ST Segment Elevation Myocardial Infarction, Unstable Angina.Increased Myocardial Infarction Risk Associated with NSAID Use.
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